Bulletin (Hospital for Joint Diseases (New York, N.Y.))
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Review Case Reports
Hernia through an iliac crest bone graft site: report of a case and review of the literature.
The iliac crest is a common donor site for autogenous bone graft as it offers the advantage of easy access and a relatively large and safe supply of bone. One of the less frequently reported complications of harvesting bone grafts from the iliac crest is a graft-site hernia. In the last decade less than 15 cases have been reported, however the true incidence of this complication is unknown. ⋯ The significant feature of this case was a large swelling six weeks postoperatively that was thought to be a hematoma. The actual diagnosis of hernia was made on the operating table during an attempt to evacuate the hematoma. Hence a high degree of suspicion is needed to diagnose a hernia following an iliac crest bone graft, particularly in obese patients and the suspicion should lead to confirmation by a CT scan.
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To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. ⋯ Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor.
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During exercise, muscular expansion and swelling occur. Chronic exertional compartment syndrome represents abnormally increased compartment pressures and pain in the involved extremity secondary to a noncompliant musculofascial compartment. Most commonly, it occurs in the lower leg, but has been reported in the thigh, foot, upper extremity, and erector spinae musculature. ⋯ However; this is not universally accepted. Other than complete cessation of causative activities, nonoperative management of CECS is usually unsuccessful. Surgical release of the involved compartments is recommended for patients who wish to continue to exercise.
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Recurrent instability in patients over forty years of age is felt to occur primarily as a result of an associated rotator cuff tear. This is often referred to as the "posterior mechanism." We reviewed our patients over the age of forty who underwent an anterior shoulder repair to identify the incidence of capsulolabral detachments and the role of an "anterior mechanism" in this patient population. A retrospective review of all patients from 1985 to 2000 was performed to identify patients who had surgery for recurrent instability that began after forty years of age. ⋯ However, all of our patients had an anterior capsulolabral detachment as the "common lesion" associated with recurrent instability. Although small, this series emphasizes the role of the "anterior mechanism" in patients who develop recurrent instability after the age of forty. A high rate of success was achieved by addressing the pathoanatomic changes identified.
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Plate fixation for unstable fractures of the proximal humerus has seen mixed results as evidenced by the trials of new methods of fixation. The deltopectoral surgical approach is most frequently used and requires significant muscle retraction and soft tissue stripping to expose the lateral humeral neck. This may contribute to avascular necrosis and fixation failure. ⋯ A recent anatomic study has demonstrated the predictability of the position of the axillary nerve as it crosses the anterior deltoid raphe, which allows it to be isolated and protected, and dissection can be extended distally. In addition, no accessory motor branches to the anterior head of the deltoid cross the raphe, so extending an incision through the raphe after protecting the main motor branch of the axillary does not place the innervation to the anterior deltoid at risk. This surgical approach allows exposure of the proximal humerus and indirect reduction of the fracture, with subsequent locking plate fixation, adhering to the principles of biological fixation.